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May 1988

Radiological Case of the Month

Author Affiliations

From the Divisions of Respiratory Diseases (Drs Colin and Allen), Anesthesia (Dr Berde), Radiology (Dr Griscom), and Orthopedics (Dr Hall), Harvard Medical School and The Children's Hospital, Boston.

Am J Dis Child. 1988;142(5):545-546. doi:10.1001/archpedi.1988.02150050083038

At age 12 years, a young man underwent posterior vertebral fusion with Harrington distraction and compression rods for correction of progressive thoracic scoliosis diagnosed when he was 8 years old. Four years after the operation, breath sounds on auscultation were decreased over the right lower portion of the chest, and roentgenography demonstrated a collapsed right lower lobe (Fig 1). The slow but progressive decrease in ventilatory function required corrective vertebral operation at age 21 years, in an attempt to obtain a mild kyphosis rather than the marked thoracic lordosis that followed his first vertebral fusion. Respiratory difficulty persisted, and the collapsed lobes in the right lung did not reexpand.

Denouement and Discussion  Bronchial Compression and Ventilatory Dysfunction in ScoliosisA xenon Xe 133 ventilation scan (Fig 2) showed absence of ventilation of the whole right lung, including the air-containing upper lobe. A computed tomographic (CT) scan (Fig 3) showed that

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